Provider Demographics
NPI:1205952264
Name:SYMONDS, LARA K (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:K
Last Name:SYMONDS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 130TH AVE NE STE 240
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1718
Mailing Address - Country:US
Mailing Address - Phone:425-646-2778
Mailing Address - Fax:425-643-2778
Practice Address - Street 1:2320 130TH AVE NE STE 240
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1718
Practice Address - Country:US
Practice Address - Phone:425-646-2778
Practice Address - Fax:425-643-2778
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11644468OtherCAQH
WA60054OtherAETNA PAYOR ID
MN708715000OtherMAGELLAN PROVIDER ID
WA306139956OtherUID
WALWEED001OtherONE HEALTH PORT PROVIDER